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Device-Related Thrombosis After Transcatheter Closure of Atrial Septal Defect Using the Gore Cardioform ASD Occluder
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Device-related thrombus formation is a rare complication found in nearly 0.2% of patients following atrial septal defect (ASD) closure with older generation ASD closure devices. We report a case of device-related thrombus complicating transcatheter ASD device closure using the Gore Cardioform ASD occluder, which consists of a thromboresistant-expanded polytetrafluoroethylene (PTFE) material over a nitinol wire frame.
A previously healthy 60-year-old woman was diagnosed with a secundum ASD measuring 23 x 12 mm on transesophageal echocardiogram (TEE). This was associated with severe right ventricular (RV) volume overload, preserved RV systolic function, and an underlying complete right bundle branch block. Apart from deficient retro-aortic rims, the ASD appeared morphologically suitable for transcatheter device closure. Transcatheter closure was undertaken in the standard fashion using right femoral vein access under intracardiac echocardiography guidance. Balloon sizing revealed a defect measuring 24 mm in the largest dimension and a 44-mm Gore Cardioform occluder device was deployed (Video). The patient was discharged on 325 mg of aspirin (ASA) daily.
One-month follow-up revealed a thrombus measuring 1.9 x 1.5 cm that was attached to the right atrial disc of the ASD occluder device (Figure A and C). No interatrial shunt was noted with agitated saline, and no left atrial thrombus was visualized. The patient had no hypercoagulable disorders or evidence of infective endocarditis. ASA was switched to oral anticoagulation with warfarin with a target international normalized ratio (INR) of 2.0 to 3.0. TEE at 3 months showed a persistent right atrial device-related thrombus. Eighty-one mg of ASA daily was added alongside an increase in the target INR to 3.0 to 3.5. Four-month follow-up TEE demonstrated resolution of the thrombus, prompting discontinuation of warfarin (Figure B and D). There was no recurrence of thrombus formation at the 18-month follow-up.
Device thrombosis is a rare complication following ASD closure with the Gore Cardioform ASD occluder device. These patients could potentially be managed conservatively with oral anticoagulation and ASA. This case highlights the importance of early postprocedural echocardiography in diagnosis.
Affiliations and Disclosures
From the Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
Informed consent statement: Written informed consent was obtained from the patient included in this case report for the publication of their clinical information and any accompanying images.
Acknowledgments: The authors would like to acknowledge Taariq Kudoos for his assistance in graphical editing.
Disclosures: The authors report no financial relationships or conflicts of interest regarding the content herein.
Address for correspondence: Anoop Mathew, MBBS, Mazankowski Alberta Heart Institute, University of Alberta Hospital, 11220 83 Avenue NW, Edmonton, AB T6G 2B7, Canada. Email: anoop.mathew@ualberta.ca; X: @anoop_alberta
